Schedule M3 Claims Repricing Retiree FY2024.xlsx

XLSX spreadsheet 557 KB Posted Nov 2, 2026

Attached to: Behavioral Health and Substance Use Disorder Benefits Admin
Solicitation number: RFP 171 260000002410 2
Issued by: Michigan

About this file

Written by GovTribe AI · Nov 3, 2026

This is a claims repricing spreadsheet for retiree behavioral health and substance use disorder benefits administration for the State of Michigan for fiscal year 2024. The document appears to be Schedule M3, which typically contains detailed claims data and repricing information related to retiree health insurance benefits. The file includes claims repricing data organized by various categories and metrics relevant to the state's retiree population receiving behavioral health and substance use disorder services.

The spreadsheet presents financial and claims-related information necessary for administering and analyzing retiree benefits under Michigan's behavioral health and substance use disorder program. The document serves as a reference tool for tracking claims repricing adjustments, costs, and related administrative data for the fiscal year 2024 period. Specific pricing terms, funding amounts, and detailed line-item costs are contained within the spreadsheet's data tables and should be reviewed in conjunction with the broader contract opportunity for Behavioral Health and Substance Use Disorder Benefits Administration to understand the complete scope of financial obligations and reimbursement structures.

View the file

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Document Cover

STATE OF MICHIGAN

Request For Proposal No. 260000002410

Behavioral Health and Substance Abuse Benefits for the State Health Plan PPO

Schedule F3, Provider Cost & Claims Data Retiree FY2024

Group: Retiree

Claim Paid Period: 01/01/2024 - 12/31/2024

Table of Contents

Tab
1	Definitions

2 Inpatient

3 Residential Treatment

4 Day Treatment

5 Outpatient

6	Intensive Outpatient Program (IOP)
7	Professional Services
Instructions:
Allowed claims paid for each place of service are summarized by TIN, then CPT/Revenue code, and then relationship status. Bidder must provide the Allowed amount in column I and Network Status in column J based the provided eligible claim amounts, provider, CPT/Revenue code information, and Bidder's fee schedule as of 01/01/2028. Definitions for network status can be found on the "Definitions" tab. Bidder must not respond "IC" to any providers that will be terminating on or after 1/1/2028, which are under contract negotiations currently and for which the network status outcome of the contract negotiations is unknown.

Bidder must not alter columns A through J or sort the information

Definitions Definitions:

· Inpatient Hospital Services – Services related only to the hospital or free standing facility charges of an acute inpatient stay.

· Residential Services – Services related only to the Non-hospital or free standing facility charges of a longer term live-in treatment facility.

· Day Treatment Services – Services related only to the delivery of day treatment regardless of setting.

· Outpatient Services – Psychiatric, psychological and substance abuse treatment expenses for providers who have direct contact with a patient. Includes medication management, psychological and substance abuse treatment from qualified providers.

· Intensive Outpatient Program Services – Services provided for 2-3 hours at a time, several days a week in a non-office setting.

· Professional Services – Provider services while the member is inpatient or in residential treatment (higher level of care).

· Eligible Billed Charges – Defined as the amount billed by the provider for benefits eligible for payment under the benefit contract. The Eligible Billed Charges exclude any duplicate claims or disallowed benefits. Claims that are not processed to determine the payment to be made to the provider (e.g. COB claims, bundled/unbundled charges) are excluded from Eligible Billed Charges.

· TIN – Provide the TIN and name of the specific provider rendering the service, even if the physician is part of a larger group practice.

· Network Status - Please use the following codes in the "network status" response field to indicate if the provider is in the network you are proposing as of 01/01/28:

Note - Bidder must not respond "IC" to any providers that will be terminating on or after 1/1/2028, which are under contract negotiations currently and for which the network status outcome of the contract negotiations is unknown.

1. "IC" - In Network Contracted: Use this code for providers with which you have a direct contract and that pay at the in-network level for members

2. "OC" - Out of Network Contracted: Use this code for providers with which you have a secondary contract through a wrap network (or "shared savings" arrangement) and pay at the out-of-network level for members

3. "IX" - In Network Non-Contracted: Use this code for providers with which you do not have a primary or secondary contract, but that pay at the in-network level for members. These types of providers would commonly include "non-member choice" providers such as hospital-based providers including radiologists, pathologists, anesthesiologists, etc. This category might also include ambulatory care and/or dialysis facilities.

4. "OX" - Out of Network Non-Contracted: Use this code for providers which you do not have a primary or secondary contract, and pay at the out-of-network level for members.

5. "OX" - Out of Network Non-Contracted: Use this code for providers which you do not have a primary or secondary contract, and pay at the out-of-network level for members.

· Provider City, State and Zip Code – Provider information should align with place of service and not billing address

· Allowed Amount – Represents the negotiated reimbursement amount for covered services before member cost sharing (e.g., deductible, copayment, or coinsurance). Amount to be populated by bidders which is based on the 01/01/28 fee schedule.

&F&A

Inpatient

Retiree claims paid 01/01/24 - 12/31/24 - Inpatient
Claim information is summarized by Provider, then CPT/Revenue Code, and then Relationship Status (employee / spouse / depdendent). Provider information aligns with place of service and not billing address.
Inpatient Services
TIN	Provider Name	Provider City	Provider State	Provider Zip Code	CPT/Revenue Code	Relationship Status (employee/ spouse/ dependent (child)	Eligible to be Billed	Allowed Amount - Based on 01/01/2028 fee schedule	Network Status

IC, OC, IX, OX

043232990	PHC OF MICHIGAN LLC	NEW BALTIMORE	MI	48047	0124	Dependent	$64,800.00
043232990	PHC OF MICHIGAN LLC	NEW BALTIMORE	MI	48047	0124	Subscriber	$18,900.00
201021264	MILLWOOD HOSPITAL LP	ARLINGTON	TX	76011	0124	Dependent	$14,000.00
232285657	FOREST VIEW PSYCHIATRIC HOSPITAL INC	GRAND RAPIDS	MI	49546	0124	Dependent	$14,400.00
260800286	BROOKSVILLE PROPERTY RESOURCES INC	BROOKSVILLE	FL	34609	0124	Spouse	$22,500.00
262512084	OAKLAND PHYSICIANS MEDICAL CENTER, LLC	PONTIAC	MI	48341	0124	Dependent	$42,984.00
262512084	OAKLAND PHYSICIANS MEDICAL CENTER, LLC	PONTIAC	MI	48341	0250	Dependent	$156.85
263333652	BCA OF DETROIT, LLC	DETROIT	MI	48205	0124	Dependent	$72,900.00
320235544	OCALA BEHAVIORAL HEALTH, LLC	OCALA	FL	34471	0124	Subscriber	$94,600.00
340715726	CLEVELAND VAMC	CLEVELAND	OH	44106	0101	Subscriber	$8,749.25
340715726	CLEVELAND VAMC	CLEVELAND	OH	44106	0240	Subscriber	$7,655.10
340715726	CLEVELAND VAMC	CLEVELAND	OH	44106	0450	Subscriber	$1,680.75
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0206	Subscriber	$12,440.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0250	Subscriber	$414.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0260	Subscriber	$1,086.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0300	Subscriber	$1,697.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0301	Subscriber	$1,268.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0305	Subscriber	$850.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0320	Subscriber	$422.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0410	Subscriber	$4,674.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0450	Subscriber	$3,404.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0460	Subscriber	$1,242.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0730	Subscriber	$576.00
352565165	WOODLAND SPRINGS, LLC	CONROE	TX	77384	0124	Dependent	$13,908.95
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0110	Subscriber	$2,657.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0250	Subscriber	$758.72
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0258	Subscriber	$12.05
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0260	Subscriber	$1,521.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0301	Subscriber	$1,390.07
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0302	Subscriber	$116.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0305	Subscriber	$207.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0306	Subscriber	$145.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0307	Subscriber	$15.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0324	Subscriber	$209.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0351	Subscriber	$1,181.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0402	Subscriber	$586.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0450	Subscriber	$2,490.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0124	Dependent	$63,105.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0250	Dependent	$855.70
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0301	Dependent	$696.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0305	Dependent	$44.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0307	Dependent	$37.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0730	Dependent	$196.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0120	Spouse	$4,991.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0120	Subscriber	$2,184.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0126	Spouse	$7,930.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0250	Spouse	$4,136.44
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0250	Subscriber	$83.16
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0301	Spouse	$1,441.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0301	Subscriber	$702.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0302	Spouse	$295.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0302	Subscriber	$151.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0305	Spouse	$103.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0305	Subscriber	$46.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0306	Spouse	$121.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0306	Subscriber	$62.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0914	Spouse	$224.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0915	Spouse	$766.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0915	Subscriber	$342.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0960	Spouse	$1,312.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0960	Subscriber	$656.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0988	Spouse	$2,675.00
381357020	HENRY FORD MAPLEGROVE CENTER	WEST BLOOMFIELD	MI	48322	0988	Subscriber	$720.00
381358208	MEMORIAL HOSPITAL	OWOSSO	MI	48867	0124	Subscriber	$2,304.90
381358208	MEMORIAL HOSPITAL	OWOSSO	MI	48867	0250	Subscriber	$101.84
381358208	MEMORIAL HOSPITAL	OWOSSO	MI	48867	0300	Subscriber	$1,533.25
381358208	MEMORIAL HOSPITAL	OWOSSO	MI	48867	0301	Subscriber	$302.75
381358208	MEMORIAL HOSPITAL	OWOSSO	MI	48867	0307	Subscriber	$49.00
381358208	MEMORIAL HOSPITAL	OWOSSO	MI	48867	0450	Subscriber	$2,281.26
381358212	HENRY FORD HEALTH PROVIDENCE HOSPITAL	SOUTHFIELD	MI	48075	0124	Spouse	$20,240.00
381358212	HENRY FORD HEALTH PROVIDENCE HOSPITAL	SOUTHFIELD	MI	48075	0250	Spouse	$294.25
381358212	HENRY FORD HEALTH PROVIDENCE HOSPITAL	SOUTHFIELD	MI	48075	0301	Spouse	$239.00
381358212	HENRY FORD HEALTH PROVIDENCE HOSPITAL	SOUTHFIELD	MI	48075	0305	Spouse	$41.00
381358212	HENRY FORD HEALTH PROVIDENCE HOSPITAL	SOUTHFIELD	MI	48075	0307	Spouse	$46.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0120	Spouse	$29,530.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0121	Spouse	$29,530.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0121	Subscriber	$11,812.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0200	Subscriber	$20,454.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0201	Spouse	$6,556.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0206	Dependent	$9,936.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0206	Spouse	$9,554.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0206	Subscriber	$9,936.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0214	Subscriber	$9,936.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0250	Dependent	$238.02
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0250	Spouse	$44,061.54
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0250	Subscriber	$9,421.01
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0255	Spouse	$260.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0255	Subscriber	$280.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0260	Spouse	$3,342.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0260	Subscriber	$6,471.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0270	Spouse	$462.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0270	Subscriber	$2,597.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0272	Subscriber	$442.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0300	Spouse	$1,536.44
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0300	Subscriber	$752.66
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0301	Dependent	$481.32
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0301	Spouse	$7,876.90
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0301	Subscriber	$5,114.64
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0302	Spouse	$16,070.78
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0302	Subscriber	$31.08
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0305	Dependent	$46.62
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0305	Spouse	$1,805.29
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0305	Subscriber	$728.16
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0306	Spouse	$2,948.65
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0306	Subscriber	$247.68
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0307	Spouse	$19.02
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0310	Spouse	$2,518.38
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0311	Spouse	$587.26
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0320	Spouse	$776.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0324	Spouse	$583.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0324	Subscriber	$788.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0343	Subscriber	$40.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0349	Spouse	$56.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0351	Spouse	$19,302.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0351	Subscriber	$2,178.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0352	Spouse	$2,178.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0352	Subscriber	$7,661.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0402	Subscriber	$321.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0410	Spouse	$5,464.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0410	Subscriber	$111.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0421	Spouse	$1,515.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0424	Spouse	$799.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0424	Subscriber	$371.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0431	Spouse	$1,138.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0434	Spouse	$657.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0434	Subscriber	$297.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0441	Spouse	$2,110.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0444	Spouse	$1,253.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0450	Spouse	$8,041.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0450	Subscriber	$4,280.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0483	Spouse	$2,336.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0610	Spouse	$2,140.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0611	Spouse	$3,358.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0611	Subscriber	$2,226.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0612	Spouse	$2,140.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0730	Spouse	$604.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0730	Subscriber	$816.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0740	Dependent	$7,426.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0740	Spouse	$1,450.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0740	Subscriber	$1,450.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0761	Subscriber	$3,815.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0762	Spouse	$7,095.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0921	Spouse	$1,241.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0921	Subscriber	$1,291.00
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0124	Spouse	$22,816.00
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0154	Spouse	$20,076.00
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0204	Spouse	$136,796.00
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0250	Spouse	$17,283.57
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0260	Spouse	$147.00
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0300	Spouse	$922.69
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0301	Spouse	$2,208.94
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0302	Spouse	$32.01
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0305	Spouse	$84.24
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0306	Spouse	$397.75
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0307	Spouse	$127.00
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0351	Spouse	$2,178.00
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0450	Spouse	$2,058.00
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0914	Spouse	$2,713.00
381360584	EDWARD W. SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0915	Spouse	$14,462.00
381368347	ELLA E. M. BROWN CHARITABLE CIRCLE	MARSHALL	MI	49068	0124	Subscriber	$22,806.00
381368347	ELLA E. M. BROWN CHARITABLE CIRCLE	MARSHALL	MI	49068	0250	Subscriber	$104.37
381368347	ELLA E. M. BROWN CHARITABLE CIRCLE	MARSHALL	MI	49068	0301	Subscriber	$305.00
381368347	ELLA E. M. BROWN CHARITABLE CIRCLE	MARSHALL	MI	49068	0450	Subscriber	$2,916.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0114	Dependent	$22,050.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0114	Spouse	$18,515.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0114	Subscriber	$31,850.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0124	Subscriber	$7,350.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0126	Spouse	$3,572.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0126	Subscriber	$16,703.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0250	Dependent	$543.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0250	Spouse	$321.12
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0250	Subscriber	$4,005.29
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0300	Dependent	$83.06
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0301	Dependent	$500.75
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0301	Spouse	$93.09
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0301	Subscriber	$620.89
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0305	Dependent	$16.97
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0305	Spouse	$31.10
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0305	Subscriber	$64.13
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0915	Spouse	$340.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0915	Subscriber	$2,556.00
381369611	MCLAREN PORT HURON	PORT HURON	MI	48060	0124	Dependent	$14,076.00
381369611	MCLAREN PORT HURON	PORT HURON	MI	48060	0250	Dependent	$976.20
381369611	MCLAREN PORT HURON	PORT HURON	MI	48060	0301	Dependent	$156.80
381437919	MYMICHIGAN MEDICAL CENTER ALMA	ALMA	MI	48801	0114	Dependent	$3,194.00
381437919	MYMICHIGAN MEDICAL CENTER ALMA	ALMA	MI	48801	0114	Spouse	$6,144.00
381437919	MYMICHIGAN MEDICAL CENTER ALMA	ALMA	MI	48801	0250	Dependent	$37.71
381437919	MYMICHIGAN MEDICAL CENTER ALMA	ALMA	MI	48801	0250	Spouse	$235.94
381437919	MYMICHIGAN MEDICAL CENTER ALMA	ALMA	MI	48801	0301	Spouse	$250.00
381437919	MYMICHIGAN MEDICAL CENTER ALMA	ALMA	MI	48801	0306	Dependent	$150.00
381437919	MYMICHIGAN MEDICAL CENTER ALMA	ALMA	MI	48801	0780	Dependent	$100.00
381576680	HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY	BRIGHTON	MI	48116	0120	Spouse	$8,800.00
381576680	HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY	BRIGHTON	MI	48116	0120	Subscriber	$1,960.00
381576680	HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY	BRIGHTON	MI	48116	0126	Spouse	$3,800.00
381576680	HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY	BRIGHTON	MI	48116	0126	Subscriber	$5,250.00
381576680	HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY	BRIGHTON	MI	48116	0914	Spouse	$375.00
381576680	HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY	BRIGHTON	MI	48116	0915	Spouse	$1,075.00
381576680	HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY	BRIGHTON	MI	48116	0915	Subscriber	$175.00
381576680	HENRY FORD HEALTH BRIGHTON CENTER FOR RECOVERY	BRIGHTON	MI	48116	0916	Spouse	$125.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0124	Dependent	$17,440.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0124	Subscriber	$64,092.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0250	Dependent	$108.86
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0250	Subscriber	$1,509.10
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0258	Subscriber	$61.85
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0260	Subscriber	$779.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0270	Subscriber	$1.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0300	Dependent	$28.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0300	Subscriber	$45.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0301	Dependent	$480.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0301	Subscriber	$1,007.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0305	Dependent	$53.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0305	Subscriber	$112.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0306	Subscriber	$494.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0307	Subscriber	$47.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0421	Subscriber	$784.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0424	Subscriber	$359.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0450	Subscriber	$2,490.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL	JACKSON	MI	49201	0730	Dependent	$199.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL, INC.	JACKSON	MI	49201	0129	Subscriber	$15,435.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL, INC.	JACKSON	MI	49201	0250	Subscriber	$391.87
382027689	W.A. FOOTE MEMORIAL HOSPITAL, INC.	JACKSON	MI	49201	0258	Subscriber	$271.49
382027689	W.A. FOOTE MEMORIAL HOSPITAL, INC.	JACKSON	MI	49201	0301	Subscriber	$71.00
382027689	W.A. FOOTE MEMORIAL HOSPITAL, INC.	JACKSON	MI	49201	0302	Subscriber	$76.00
382233166	COMMUNITY PROGRAMS INC.	WATERFORD	MI	48327	0120	Subscriber	$5,600.00
382233166	COMMUNITY PROGRAMS INC.	WATERFORD	MI	48327	0300	Subscriber	$56.00
382233166	COMMUNITY PROGRAMS INC.	WATERFORD	MI	48327	0914	Subscriber	$570.00
382233166	COMMUNITY PROGRAMS INC.	WATERFORD	MI	48327	0915	Subscriber	$680.00
382233166	COMMUNITY PROGRAMS INC.	WATERFORD	MI	48327	0919	Subscriber	$570.00
382409580	HAVENWYCK HOSPITAL INC	ST JOHNS	MI	48879	0124	Dependent	$26,000.00
382409580	HAVENWYCK HOSPITAL INC	ST JOHNS	MI	48879	0124	Spouse	$22,000.00
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0124	Dependent	$9,582.00
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0124	Spouse	$23,388.80
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0124	Subscriber	$93,555.20
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0250	Dependent	$51.00
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0250	Spouse	$960.57
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0250	Subscriber	$4,567.90
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0270	Spouse	$1.24
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0270	Subscriber	$10.15
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0272	Subscriber	$5.05
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0301	Dependent	$94.00
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0301	Spouse	$922.00
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0301	Subscriber	$1,997.65
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0305	Spouse	$144.30
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0305	Subscriber	$144.45
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0306	Spouse	$303.00
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0306	Subscriber	$156.00
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0307	Spouse	$64.15
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0307	Subscriber	$29.15
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0309	Spouse	$44.60
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0309	Subscriber	$89.20
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0450	Spouse	$1,391.55
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0450	Subscriber	$1,391.55
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0730	Spouse	$231.70
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0730	Subscriber	$695.10
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0771	Subscriber	$156.00
382602147	MYMICHIGAN MEDICAL CENTER SAULT	KINCHELOE	MI	49788	0780	Spouse	$188.00
382689033	MCLAREN LAPEER REGION	LAPEER	MI	48446	0124	Dependent	$13,140.00
382689033	MCLAREN LAPEER REGION	LAPEER	MI	48446	0250	Dependent	$368.56
382689033	MCLAREN LAPEER REGION	LAPEER	MI	48446	0301	Dependent	$366.40
382689033	MCLAREN LAPEER REGION	LAPEER	MI	48446	0302	Dependent	$42.60
382689033	MCLAREN LAPEER REGION	LAPEER	MI	48446	0305	Dependent	$38.10
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0110	Spouse	$4,600.00
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0250	Spouse	$176.53
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0258	Spouse	$80.00
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0260	Spouse	$1,777.00
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0301	Spouse	$1,546.00
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0305	Spouse	$122.00
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0402	Spouse	$697.00
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0421	Spouse	$105.00
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0424	Spouse	$267.00
382947657	HENRY FORD MACOMB HOSPITAL CORPORATION	CLINTON TWP	MI	48038	0450	Spouse	$2,371.00
383322109	HENRY FORD HEALTH MACOMB-OAKLAND HOSPITAL	WARREN	MI	48093	0124	Dependent	$8,415.00
383322109	HENRY FORD HEALTH MACOMB-OAKLAND HOSPITAL	WARREN	MI	48093	0250	Dependent	$652.00
383322109	HENRY FORD HEALTH MACOMB-OAKLAND HOSPITAL	WARREN	MI	48093	0300	Dependent	$134.00
383322109	HENRY FORD HEALTH MACOMB-OAKLAND HOSPITAL	WARREN	MI	48093	0301	Dependent	$527.00
383322109	HENRY FORD HEALTH MACOMB-OAKLAND HOSPITAL	WARREN	MI	48093	0305	Dependent	$67.00
383322109	HENRY FORD HEALTH MACOMB-OAKLAND HOSPITAL	WARREN	MI	48093	0307	Dependent	$91.00
383322109	HENRY FORD HEALTH MACOMB-OAKLAND HOSPITAL	WARREN	MI	48093	0450	Dependent	$2,454.00
383322109	HENRY FORD HEALTH MACOMB-OAKLAND HOSPITAL	WARREN	MI	48093	0762	Dependent	$3,200.00
383473188	T & G CORPORATION INC	WARREN	MI	48092	0124	Dependent	$16,500.00
383473188	T & G CORPORATION INC	WARREN	MI	48092	0250	Dependent	$331.31
383473188	T & G CORPORATION INC	WARREN	MI	48092	0300	Dependent	$77.80
384149930	SANFORD WEST LLC	MARNE	MI	49435	0120	Spouse	$97,500.00
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0124	Dependent	$161,403.00
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0250	Dependent	$1,959.14
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0300	Dependent	$204.31
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0301	Dependent	$518.23
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0302	Dependent	$51.88
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0305	Dependent	$49.00
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0306	Dependent	$57.02
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0307	Dependent	$8.50
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0310	Dependent	$790.32
386000134	STATE OF MICHIGAN	WESTLAND	MI	48186	0771	Dependent	$57.00
386004889	HEALTHSOURCE SAGINAW INC	SAGINAW	MI	48603	0124	Subscriber	$20,515.00
386004889	HEALTHSOURCE SAGINAW INC	SAGINAW	MI	48603	0250	Subscriber	$185.83
391139101	ROGERS MEMORIAL HOSPITAL INCORPORATED	OCONOMOWOC	WI	53066	0124	Dependent	$23,800.00
461765556	PACIFIC BAY RECOVERY INC	JAMUL	CA	91935	0158	Subscriber	$2,700.00
474195292	YARROW LODGE, LLC	AUGUSTA	MI	49012	0120	Spouse	$32,742.00
474195292	YARROW LODGE, LLC	AUGUSTA	MI	49012	0120	Subscriber	$32,742.00
474195292	YARROW LODGE, LLC	AUGUSTA	MI	49012	0126	Subscriber	$11,250.00
596012500	SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT	SARASOTA	FL	34239	0124	Subscriber	$84,180.00
596012500	SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT	SARASOTA	FL	34239	0250	Subscriber	$3,357.87
596012500	SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT	SARASOTA	FL	34239	0300	Subscriber	$133.53
596012500	SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT	SARASOTA	FL	34239	0301	Subscriber	$1,925.00
596012500	SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT	SARASOTA	FL	34239	0305	Subscriber	$104.00
596012500	SARASOTA COUNTY PUBLIC HOSPITAL DISTRICT	SARASOTA	FL	34239	0351	Subscriber	$4,176.00
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0111	Subscriber	$11,408.00
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0121	Subscriber	$9,291.66
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0250	Subscriber	$17,140.17
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0258	Subscriber	$1,148.90
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0259	Subscriber	$2,488.68
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0272	Subscriber	$3,715.75
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0301	Subscriber	$11,415.82
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0302	Subscriber	$22.69
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0305	Subscriber	$26,877.18
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0306	Subscriber	$7,167.44
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0307	Subscriber	$630.11
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0320	Subscriber	$438.30
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0324	Subscriber	$438.30
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0350	Subscriber	$16,199.04
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0351	Subscriber	$40,445.94
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0402	Subscriber	$3,596.57
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0420	Subscriber	$6,037.68
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0424	Subscriber	$1,209.10
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0430	Subscriber	$2,996.00
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0434	Subscriber	$2,096.03
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0440	Subscriber	$324.28
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0450	Subscriber	$10,534.60
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0480	Subscriber	$14,425.02
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0730	Subscriber	$399.91
611269294	NORTH FLORIDA REGIONAL MEDICAL CENTER, INC.	GAINESVILLE	FL	32605	0921	Subscriber	$9,908.10
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0121	Spouse	$7,260.00
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0250	Spouse	$670.36
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0258	Spouse	$104.00
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0301	Spouse	$9,746.55
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0305	Spouse	$1,592.36
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0307	Spouse	$413.82
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0351	Spouse	$13,582.93
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0450	Spouse	$4,779.00
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0636	Spouse	$248.50
621113740	HCA HEALTH SERVICES OF FLORIDA, INC.	BRADENTON	FL	34209	0730	Spouse	$738.10
742664821	ESPERANZA HEALTH SYSTEMS, LTD	HUNT	TX	78024	0126	Subscriber	$28,500.00
800818718	DLP MARQUETTE GENERAL HOSPITAL LLC	MARQUETTE	MI	49855	0114	Spouse	$23,112.98
800818718	DLP MARQUETTE GENERAL HOSPITAL LLC	MARQUETTE	MI	49855	0300	Spouse	$328.89
800818718	DLP MARQUETTE GENERAL HOSPITAL LLC	MARQUETTE	MI	49855	0301	Spouse	$1,437.54
800818718	DLP MARQUETTE GENERAL HOSPITAL LLC	MARQUETTE	MI	49855	0302	Spouse	$207.45
800818718	DLP MARQUETTE GENERAL HOSPITAL LLC	MARQUETTE	MI	49855	0305	Spouse	$156.09
800818718	DLP MARQUETTE GENERAL HOSPITAL LLC	MARQUETTE	MI	49855	0307	Spouse	$252.66
800818718	DLP MARQUETTE GENERAL HOSPITAL LLC	MARQUETTE	MI	49855	0309	Spouse	$257.15
800818718	DLP MARQUETTE GENERAL HOSPITAL LLC	MARQUETTE	MI	49855	0450	Spouse	$3,090.60
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0110	Dependent	$1,975.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0250	Dependent	$443.80
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0260	Dependent	$634.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0300	Dependent	$112.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0301	Dependent	$2,865.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0305	Dependent	$244.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0307	Dependent	$97.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0351	Dependent	$1,989.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0450	Dependent	$3,476.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0611	Dependent	$3,480.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0730	Dependent	$180.00
811723202	PRISMA HEALTH-UPSTATE	EASLEY	SC	29640	0740	Dependent	$1,198.00
822335258	GAYLORD OPCO, LLC	GAYLORD	MI	49735	0420	Spouse	$13,796.00
822335258	GAYLORD OPCO, LLC	GAYLORD	MI	49735	0424	Spouse	$336.00
822335258	GAYLORD OPCO, LLC	GAYLORD	MI	49735	0430	Spouse	$7,283.00
822335258	GAYLORD OPCO, LLC	GAYLORD	MI	49735	0434	Spouse	$181.00
822335258	GAYLORD OPCO, LLC	GAYLORD	MI	49735	0440	Spouse	$5,903.00
822335258	GAYLORD OPCO, LLC	GAYLORD	MI	49735	0444	Spouse	$780.00
831978365	MICHIGAN BH JV, LLC	DEARBORN	MI	48124	0124	Dependent	$30,000.00
831978365	MICHIGAN BH JV, LLC	DEARBORN	MI	48124	0124	Subscriber	$14,000.00
834598911	BH NEWCO HOSPITAL LLC	SCOTTSDALE	AZ	85258	0124	Dependent	$11,000.00
842814288	DOWELL SPRINGS BEHAVIORAL HEALTH, LLC	KNOXVILLE	TN	37909	0124	Dependent	$40,000.00
842900539	AVENUES RECOVERY CENTER OF LAKE ARIEL, LLC	LAKE ARIEL	PA	18436	0126	Subscriber	$49,500.00

Residential Treatment

Retiree claims paid 01/01/24 - 12/31/24 - Residential Treatment
Claim information is summarized by Provider, then CPT/Revenue Code, and then Relationship Status (employee / spouse / depdendent). Provider information aligns with place of service and not billing address.
Residential Services
TIN	Provider Name	Provider City	Provider State	Provider Zip Code	CPT/Revenue Code	Relationship Status (employee/ spouse/ dependent (child)	Eligible to be Billed	Allowed Amount - Based on 01/01/2028 fee schedule	Network Status

IC, OC, IX, OX

384149930	SANFORD WEST LLC	MARNE	MI	49435	0126	Spouse	$24,000.00
452974402	GREENHOUSE TREATMENT CENTER, LLC	GRAND PRAIRIE	TX	75050	1002	Dependent	$72,250.00
461912262	BLACK BEAR TREATMENT CENTER LLC	SAUTEE	GA	30571	1002	Spouse	$17,334.00
811417491	JOSHUA HOUSE, LLC	GARDEN GROVE	CA	92844	0156	Subscriber	$33,075.00
811417491	JOSHUA HOUSE, LLC	GARDEN GROVE	CA	92844	1002	Subscriber	$4,125.00
842900539	AVENUES RECOVERY CENTER OF LAKE ARIEL, LLC	LAKE ARIEL	PA	18436	1002	Subscriber	$11,400.00
851648079	FIRST CITY RECOVERY CENTER	KOKOMO	IN	46901	1002	Dependent	$6,400.00
883836765	INDIANA CENTER FOR RECOVERY INDIANAPOLIS	INDIANAPOLIS	IN	46237	1002	Dependent	$136,880.00
883982880	WHITE LIGHT BEHAVIORAL HEATH COLUMBUS, LLC	COLUMBUS	OH	43213	0126	Subscriber	$59,250.00
883982880	WHITE LIGHT BEHAVIORAL HEATH COLUMBUS, LLC	COLUMBUS	OH	43213	1002	Subscriber	$40,800.00
900485646	LA JOLLA RECOVERY INC	SAN DIEGO	CA	92109	0156	Subscriber	$12,150.00
900485646	LA JOLLA RECOVERY INC	SAN DIEGO	CA	92109	1002	Subscriber	$13,800.00

Day Treatment

Retiree claims paid 01/01/24 - 12/31/24 - Day Treatment
Claim information is summarized by Provider, then CPT/Revenue Code, and then Relationship Status (employee / spouse / depdendent). Provider information aligns with place of service and not billing address.
Day Treatment Services
TIN	Provider Name	Provider City	Provider State	Provider Zip Code	CPT/Revenue Code	Relationship Status (employee/ spouse/ dependent (child)	Eligible to be Billed	Allowed Amount - Based on 01/01/2028 fee schedule	Network Status

IC, OC, IX, OX

380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0912	Subscriber	$6,000.00
381360584	EDWARD W SPARROW HOSPITAL ASSOCIATION	LANSING	MI	48912	0912	Dependent	$5,368.00
381368360	BERTRAND, MORGAN	GRAND RAPIDS	MI	49548	99232	Dependent	$181.00
381368360	LEAVITT, KAREN	WINTER PARK	FL	32792	99223	Dependent	$418.00
381368360	LEAVITT, KAREN	WINTER PARK	FL	32792	99232	Dependent	$378.00
381368360	LEAVITT, KAREN	WINTER PARK	FL	32792	99239	Dependent	$269.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0912	Dependent	$6,898.00
381368360	PINE REST CHRISTIAN MENTAL HEALTH SERVICES	GRAND RAPIDS	MI	49548	0912	Spouse	$4,780.00
381437919	MYMICHIGAN MEDICAL CENTER ALMA	ALMA	MI	48801	0912	Dependent	$7,200.00
381917674	BEAUCHAMP, AMY	GRAND RAPIDS	MI	49548	99223	Dependent	$1,206.00
381917674	BEAUCHAMP, AMY	GRAND RAPIDS	MI	49548	99232	Dependent	$543.00
381917674	BEAUCHAMP, AMY	GRAND RAPIDS	MI	49548	99239	Dependent	$516.00
382409580	HAVENWYCK HOSPITAL INC	ST JOHNS	MI	48879	0912	Dependent	$4,950.00
382409580	SISCO, KRYN	LANSING	MI	48910	99231	Dependent	$90.00
383006825	ISMAIL B. SENDI, MD, PC	CLARKSTON	MI	48346	S0201	Dependent	$6,300.00
383006825	ISMAIL B. SENDI, MD, PC	CLARKSTON	MI	48346	S0201	Subscriber	$10,100.00
385114041	HUNTOON, CARL	ALMA	MI	48801	99222	Dependent	$215.00
386006309	REGENTS OF THE UNIVERSITY OF MICHIGAN	ANN ARBOR	MI	48109	0912	Dependent	$15,763.00
391139101	ROGERS MEMORIAL HOSPITAL INCORPORATED	OCONOMOWOC	WI	53066	0912	Dependent	$7,140.00
438655607	MINOR, DARLINDA	HOUSTON	TX	77002	99238	Dependent	$193.00
465723097	WESTSIDE TREATMENT, LLC.	LOS ANGELES	CA	90064	0913	Subscriber	$2,025.00
474195292	YARROW LODGE, LLC	AUGUSTA	MI	49012	0912	Spouse	$14,520.00
474315149	HARBOR OF GRACE ENHANCED RECOVERY CENTER	HAVRE DE GRACE	MD	21078	0912	Spouse	$19,745.00
742664821	ESPERANZA HEALTH SYSTEMS, LTD	HUNT	TX	78024	0913	Subscriber	$35,100.00
800966827	AAC DALLAS OUTPATIENT CENTER, LLC	ARLINGTON	TX	76006	0913	Dependent	$14,500.00
814003779	PACIFIC RECOVERY SOLUTIONS	LOS ANGELES	CA	90048	0913	Subscriber	$82,500.00
824700551	ALEEM, ASAF	FORT MYERS	FL	33919	90870	Subscriber	$674.00
843774782	HILLSDALE TREATMENT CENTER LLC	SANTA ANA	CA	92701	0913	Subscriber	$61,035.00

Outpatient

Retiree claims paid 01/01/24 - 12/31/24 - Outpatient
Claim information is summarized by Provider, then CPT/Revenue Code, and then Relationship Status (employee / spouse / depdendent). Provider information aligns with place of service and not billing address.
Outpatient Services
TIN	Provider Name	Provider City	Provider State	Provider Zip Code	CPT/Revenue Code	Relationship Status (employee/ spouse/ dependent (child)	Eligible to be Billed	Allowed Amount - Based on 01/01/2028 fee schedule	Network Status

IC, OC, IX, OX

203500835	CLARKSVILLE HEALTH SYSTEM, LLC	CLARKSVILLE	TN	37040	0250	Dependent	$243.37
203500835	CLARKSVILLE HEALTH SYSTEM, LLC	CLARKSVILLE	TN	37040	0300	Dependent	$33.44
203500835	CLARKSVILLE HEALTH SYSTEM, LLC	CLARKSVILLE	TN	37040	0301	Dependent	$4,743.43
203500835	CLARKSVILLE HEALTH SYSTEM, LLC	CLARKSVILLE	TN	37040	0307	Dependent	$119.50
203500835	CLARKSVILLE HEALTH SYSTEM, LLC	CLARKSVILLE	TN	37040	0450	Dependent	$4,233.31
203500835	CLARKSVILLE HEALTH SYSTEM, LLC	CLARKSVILLE	TN	37040	0636	Dependent	$318.00
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0300	Dependent	$24.00
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0301	Dependent	$1,005.00
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0305	Dependent	$84.00
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0306	Dependent	$141.00
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0307	Dependent	$33.00
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0309	Subscriber	$17.34
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0450	Dependent	$748.00
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0450	Subscriber	$719.00
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0521	Subscriber	$240.01
208756459	MACKINAC STRAITS HEALTH SYSTEM INC	SAINT IGNACE	MI	49781	0730	Subscriber	$176.00
237249643	SAULT TRIBE OF CHIPPEWA INDIANS	SAULT SAINTE MARIE	MI	49783	0521	Spouse	$250.00
240798839	WAYNE MEMORIAL HOSPITAL	HONESDALE	PA	18431	0300	Subscriber	$773.00
262955988	THE PAVILION AT HEALTHPARK LLC	FORT MYERS	FL	33908	0901	Subscriber	$3,300.00
264299275	UPPER GREAT LAKES FAMILY HEALTH CENTER	CALUMET	MI	49913	0521	Subscriber	$397.00
270712680	BEAVERCREEK MEDICAL CENTER	BEAVERCREEK	OH	45431	0352	Spouse	$1,770.00
270712680	BEAVERCREEK MEDICAL CENTER	BEAVERCREEK	OH	45431	0402	Spouse	$1,039.00
272844632	VHS SINAI-GRACE HOSPITAL INC	DETROIT	MI	48235	0510	Spouse	$1,460.00
272844632	VHS SINAI-GRACE HOSPITAL INC	DETROIT	MI	48235	0513	Spouse	$896.00
272844632	VHS SINAI-GRACE HOSPITAL INC	DETROIT	MI	48235	0900	Spouse	$1,218.00
273672239	ISABELLA CITIZENS FOR HEALTH, INC.	MT PLEASANT	MI	48858	0521	Subscriber	$447.50
310540155	DAYTON VAMC	DAYTON	OH	45428	0510	Subscriber	$371.26
314394942	OHIOHEALTH CORPORATION	COLUMBUS	OH	43215	0250	Dependent	$8.55
314394942	OHIOHEALTH CORPORATION	COLUMBUS	OH	43215	0260	Dependent	$668.00
314394942	OHIOHEALTH CORPORATION	COLUMBUS	OH	43215	0450	Dependent	$1,675.00
314394942	OHIOHEALTH CORPORATION	COLUMBUS	OH	43215	0636	Dependent	$105.10
340967014	MEDICAL UNIVERSITY OF OHIO AT TOLEDO	TOLEDO	OH	43614	0352	Subscriber	$1,020.00
340967014	MEDICAL UNIVERSITY OF OHIO AT TOLEDO	TOLEDO	OH	43614	0403	Subscriber	$581.00
341883132	BAY PARK COMMUNITY HOSPITAL	OREGON	OH	43616	0352	Subscriber	$809.00
344428256	THE TOLEDO HOSPITAL	TOLEDO	OH	43606	0921	Subscriber	$2,507.00
350877574	ELKHART GENERAL HOSPITAL, INC.	ELKHART	IN	46514	0350	Subscriber	$208.00
352528741	VANDERBILT UNIVERSITY MEDICAL CENTER	NASHVILLE	TN	37232	0510	Spouse	$500.00
352528741	VANDERBILT UNIVERSITY MEDICAL CENTER	NASHVILLE	TN	37232	0914	Spouse	$898.00
362513909	CENTRAL DUPAGE HOSPITAL ASSOCIATION	WINFIELD	IL	60190	0301	Subscriber	$296.00
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0250	Dependent	$239.50
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0258	Dependent	$15.00
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0271	Dependent	$65.70
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0272	Dependent	$2,146.94
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0307	Dependent	$174.00
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0312	Dependent	$2,036.00
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0360	Dependent	$47,463.00
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0370	Dependent	$5,928.00
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0636	Dependent	$607.25
370960170	NORTHWESTERN MEMORIAL HOSPITAL	CHICAGO	IL	60611	0710	Dependent	$3,726.00
380350304	MUNSON HEALTHCARE MANISTEE HOSPITAL	MANISTEE	MI	49660	0250	Spouse	$41.05
380350304	MUNSON HEALTHCARE MANISTEE HOSPITAL	MANISTEE	MI	49660	0300	Spouse	$33.00
380350304	MUNSON HEALTHCARE MANISTEE HOSPITAL	MANISTEE	MI	49660	0301	Spouse	$1,980.00
380350304	MUNSON HEALTHCARE MANISTEE HOSPITAL	MANISTEE	MI	49660	0305	Spouse	$96.00
380350304	MUNSON HEALTHCARE MANISTEE HOSPITAL	MANISTEE	MI	49660	0307	Spouse	$211.00
380350304	MUNSON HEALTHCARE MANISTEE HOSPITAL	MANISTEE	MI	49660	0352	Subscriber	$666.00
380350304	MUNSON HEALTHCARE MANISTEE HOSPITAL	MANISTEE	MI	49660	0450	Spouse	$1,455.00
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0300	Spouse	$86.50
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0301	Spouse	$1,746.25
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0302	Spouse	$67.50
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0305	Spouse	$181.50
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0306	Spouse	$75.00
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0324	Spouse	$144.75
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0450	Spouse	$2,417.00
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0460	Spouse	$145.75
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0510	Subscriber	$42.00
380593405	METROPOLITAN HOSPITAL	WYOMING	MI	49519	0730	Spouse	$82.50
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0260	Subscriber	$178.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0300	Dependent	$78.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0301	Dependent	$1,653.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0301	Spouse	$240.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0301	Subscriber	$915.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0305	Dependent	$144.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0305	Subscriber	$96.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0307	Dependent	$78.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0324	Subscriber	$331.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0350	Subscriber	$2,001.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0450	Dependent	$598.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0450	Subscriber	$1,418.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0510	Spouse	$82.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0540	Subscriber	$3,275.50
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0636	Subscriber	$3.00
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0637	Subscriber	$67.65
380833014	MYMICHIGAN MEDICAL CENTER MIDLAND	MIDLAND	MI	48670	0730	Subscriber	$218.00
381303843	MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL	GAYLORD	MI	49735	0301	Spouse	$207.00
381303843	MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL	GAYLORD	MI	49735	0305	Spouse	$73.00
381303843	MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL	GAYLORD	MI	49735	0352	Spouse	$656.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0258	Spouse	$20.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0260	Spouse	$569.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0270	Spouse	$108.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0300	Subscriber	$15.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0301	Spouse	$360.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0301	Subscriber	$536.59
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0305	Spouse	$46.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0307	Spouse	$15.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0320	Spouse	$293.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0421	Spouse	$1,935.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0450	Spouse	$2,490.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0450	Subscriber	$3,498.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0510	Spouse	$232.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0636	Spouse	$7.67
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0730	Spouse	$98.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0914	Subscriber	$60.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0918	Spouse	$98.00
381357020	HENRY FORD HEALTH SYSTEM	DETROIT	MI	48202	0918	Subscriber	$1,342.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0250	Dependent	$7.19
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0258	Dependent	$20.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0260	Dependent	$504.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0270	Dependent	$108.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0301	Dependent	$1,025.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0305	Dependent	$46.00
381357020	HENRY FORD HEALTH SYSTEM	WEST BLOOMFIELD	MI	48322	0307	Dependent	$15.00

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Nov 3, 2026.